Forms for Your First Appointment with
San Diego Therapist Dr. Madeline Long

Forms in English

For your convenience, you can download the necessary forms for your first appointment with Dr. Long, complete them and bring them with you to your first appointment.

• Child Data Form
• Client Data Form
• Fee Contract
• Consent to Use and Disclose Your Health Information
• Informed Consent for Treatment
• Notice of Privacy Practices

Formas en español

Favor de escoger la propia forma abajo. Imprima la forma. Llene la información correcta y traiga las formas a su primera cita.

• Forma De Datos Del Niño
• Forma De Datos Del Cliente
• Contrato De Honorario
• Consentimiento Para Utilizar Y Revelar Su Información De Salud
• Consentimiento Informado Para el Tratamiento
• Aviso Sobre Las Practicás Privadas

Directions to Dr. Long's San Diego Office

A map to Dr. Long's office, which can be printed, is available on Dr. Long's clinical services page.